Our Work in Health, Social Services and Education

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Consulting to the public sector provides special challenges. Demographic and economic factors combine to produce important changes in social infrastructure. The major components of this infrastructure - health care institutions, social service programs, and schools, colleges and universities - have become established means of investing in the future. This investment, however, has significant operating cost implications. Health, social services and education consume the major portion of public expenditures in Canada and similar levels in other developed countries. Understanding these three program areas and developing necessary and appropriate policies, planning systems and capital development plans present an enormous challenge to those responsible for funding, managing and providing services.

RMC and its members are experienced in working with government and with such public sector enterprises as hospitals, social service centres, colleges and universities. This public sector work is counterpoint to our private sector consulting for large and small industrial clients. In this way we are able to evolve concepts that are transferable between the private and public sectors. However, while many planning and management techniques are transferable, they must be carefully evaluated in the context of the special sensitivities that exist for governments, institutional governing boards, program advisory committees and the wide range of professionals who both serve the public and administer programs in health, social services and education.

The backgrounds of RMC's professional staff reflect our experience in diverse fields such as population control and community health; health services administration and delivery; care of the elderly; family support and income maintenance; post-secondary education administration and delivery; and capital development for all sectors ranging from strategic/master planning to architecture. These backgrounds are complemented by the capabilities of our colleagues in the corporate planning, information systems, human resources, and productivity improvement parts of our practice. For more information on our work with health authorities and hospitals, please refer to the next section titled Our Work in Facility Planning.

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Health and Social Services

Members of RMC have been involved, both nationally and internationally, in health and social services projects as diverse as countrywide comprehensive health care restructuring; the establishment of regional health authorities; the development of management planning and control systems and specialty studies for individual institutions; and assisting clients to manage complex technical and capital works projects.

Typical Assignments

• Republic of Azerbaijan 2007-2008
  
  The Development of a National Health Workforce and Infrastructure Master Plan for the Ministry Of Health. Important fearures of the master planning work is the integration of health workforce and hospital facility issues with direct links to the primary health care system, and priority setting for the assessment and planning in 5 pilot regions. The project's enphasis is on the following areas:

• Modeling improved delivery system: structure , inter-linkages, referral networks
• Setting policies, targets: for resource supply, utilization , efficient service
• Estimating facility needs: population and policy-based volumes and mix services
• Estimating workforce needs: team composition, efficient service staffing
• Identifying resource requirements and deployment: infrastructure and human resources
• Specifying special arrangements: isolated areas, particular service needs
• Determining system management structure and operations: local and regional levels
• Identifying implementation requirements: training, policies, sequencing issues
• Conducting consensus building workshops
• Presenting the Master Plan to local authorities, MoF, MoH and other counterparts

The PHC National Master Plan (Ambulatory Services/Clinics), in turn, to define the role (type and extent) of the three regional hospitals which are slated to be replaced.




• Republic of Georgia 2004-2006
  
  The development of a National Master plan for Health Workforce and Infrastructure and to assist the Ministry of Labour, Health and Social Affairs (PHC Coordination Board) in developing and implementing a more effective system of allocation of health care resources for PHC in Georgia. Major elements of the WB funded project included the following:

• Drafting Terms of Reference for the GIS Software
• Conducting an inventory of PHC facilities and PHC workforce, providing the recommendations on optimum methods and composition of PHC team
• Providing an inventory of PHC network, work force size and structure
• Rationalizing of Health Service Delivery
• Making recommendations for a model of affordable and sustainable primary care for Georgia, based on evaluation of alternatives
• Applying the documented methodology and supporting tools to determine the PHC resource; assessing and documenting the needs for PHC; and the composition of the PHC Team
• Defining the functional linkages to inpatient care, diagnostic services, specialty out-patient care and public health and administrative institutions
• Developing a plan for a facility and health workforce rationalization
• Developing models of referrals from PHC to other levels of the health care system
• Conducting Consensus Building Workshops

• Alberta Health and Wellness, Evaluation of Non Prescription Needle Use Initiative 2004-2007.
  
  RMC will work with key stakeholders to develop and implement the evaluation plan that will define and measure both process and outcome indicators to determine if the NPNU Initiative is meeting its goal to reduce the harms associated with injection drug use in Alberta.
  

• The Glenrose Rehabilitation Hospital of Capital Health, Evaluation of the Syncrude Centre for Motion and Balance Project (2004)
  
  The RMC evaluation team worked in collaboration with the Syncrude Centre for Motion and Balance (SCMB) Project personnel and the Provincial Evaluation Coordination Team to conduct the evaluation over three years. The Health Innovation Fund (HIF) framework was used to guide the inquiry so that the experience and knowledge gained through project evaluation informed planning processes at regional as well as provincial levels. The findings and key learnings from the evaluation were applied to answer the questions posed in the following two-part framework. A Formative Evaluation assessed the development and implementation of the program, provided feedback and thereby contributed to the improvement of program delivery (Process Evaluation). A Summative Evaluation examined program and client outcomes to identify if the program made a difference (Outcome Evaluation).
  

• Indonesia 2002
  
  RMC was awarded a WB Health Workforce and Services project in Indonesia to assist the MoH, Ministry of National Education and Indonesia Medical Association and the provinces in their joint effort to improve their institutional capacity for human resources policy and planning in accordance with the current and future health care needs of the population.
  

• Trinidad & Tobago 1999-2005
  
  As part of the $134 million IDB funded Health Sector Reform Programme, RMC was retained by the MOH of Trinidad & Tobago to assist the Project Administration Unit in the selection of appropriate consultants, the evaluation of their work and the administration of their contracts involving some 100 technical assistance projects encompassing:

• Reform of the Ministry of Health
• Devolution of Service Delivery to RHA
• PHC Development, Promotion & Training
• Rationalizing of Health Service Delivery
• Development of a Comprehensive Financing System and, in the process, transfer such knowledge, skills and systems to the MOH and RHAs.

Also acting as advisors to the Minister and senior Ministry officials on policy issues arising from the health care restructuring, as well as to undertake, on a sole-source basis, a number of the consultancies; the most significant over the recent past include:

• National Health Insurance. Provided advice to the MOH regarding health financing/cost recovery as a prelude to the introduction of a NHI scheme. Organized two seminars with internationally recognized experts as speakers, attended by major stakeholders.
• The development of a National Emergency Medical Services (NEMS) policy and operational framework including: situation analysis; medical direction; integration into hospital services; scope and funding; human resources/training; MIS and preventive maintenance. Also prepared a Tender Document to effect out-sourcing of day-to-day management of NEMS.
• Pharmaceutical Services. Assessed the strength and weaknesses provided by the private and public sectors throughout T&T and provided advice and assistance in the design of chronic disease drug program for the population 65+ and the disabled in-cluding monitoring assistance during pro-gramme implementation (Phase I); Developed a National Pharmaceutical services plan including products to be available (public/private); National Drug Formulary (content and administration); procurement, storage and distribution; financial implications, projected budgets and funding options; policy, legislation, human resources, organization systems; implementation time-frame (Phase 2).
• National Needs Assessment (NNA). The overall objective of the project was to facilitate the development of NNA capacity in the MOH of T&T and in so doing to enable the RHAs to assess health care needs, prioritize the needs and inter-ventions in the most efficient and effective manner. Also to train and build capacity within the RHAs to be able to carry out NNA in the future and to incorporate NNA as part of their annual regional health care plans.

• Albania 1999-2001
  
  Retained to provide financial management and procurement advisory services to the Albania Ministry of Health, PCU on a USD17 million W.B. funded Health Systems Recovery and Development Project to rationalize and strengthen the governance structure and management capacity at the national and regional levels and to improve the effectiveness and quality of health service delivery in the Tirana Region.

• Alberta Health & Wellness 2001
  
  RMC was commissioned by the Alberta Provincial Health & Wellness Department to revise the 1995 Health Needs Assessment Guide so that it is "user friendly" and incorporates new information, approaches and language, e.g. Accountability Framework, Expectations and Measures; Health Authority Business Plan and Annual Requirements; Health Trends; RHA Health Needs Assessment Review and Expectations. RMC worked with a committee from seven of the RHAs and the Ministry. The revised guide incorporates key planning information from the RHAs, e.g. their successes, anecdotal information, etc., and reference material.

• Guyana 1999-2000
  
  Health Sector Policy and Institutional Development Program funded by IADB. The 20 month project, with 63 person-months of professional level of effort dealt with health policy; legal and regulatory issues; health economics/financing; financial management/ MIS; health planning/epidemiology; public health/PHC; health services management; human resource development and management; hospital administration; quality assurance; health education and promotion. (1999-2000).

• Ministry of Health, Ontario 1997-1998
  
  Secondment of a Senior Principal for a one-year period to be the Director of the Program Management Office (PMO) of a Smart Systems for Health project of the Ontario Ministry of Health. The objectives of the PMO was to design infrastructure to deliver Smart System products and services; establish standards and policy for the future use of technology; recommend governance, financing and security policies; coordinate efforts of health sector and technology partners; and raise health policy issues for determination by the Ministry of Health. About 80 professionals, including three from RMC, were involved during the course of the project.

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• Hungary 1997
  
  Development and execution of a three-day conference in Budapest, Hungary entitled Hospital Based Management Information Systems - The Canadian Experience under the auspices of the World Bank, the Canadian and Ontario Governments and attended by senior Ministry of Health officials from Central and Eastern Europe, the Baltic Republics and former Soviet states.

• Lloydminister, Saskatchewan 1997
  
  Conducted a needs assessment study that dealt with identifying continuing/long term care directions in the Lloydminster Health District (Saskatchewan). The study entailed: developing population and long term care bed forecasts; researched trends in long term care delivery; interviewed key stakeholders; conducted focus group with area residents; and developed program alternatives.

• Westview Regional Health Authority 1997
  
  Retained by the WestView Regional Health Authority (Alberta) to conduct a regional health needs assessment. The study work plan included: an analysis of demographic and health status information; stakeholder and community input through the use of stake-holder work sessions, community focus groups and a telephone survey of 600 residents; the identification and validation of health needs.
  
  RMC assisted the WestView Health Region to develop terms of reference for private partnerships in the design and operation of continuing care beds in the Hinton and Evansburg communities.

• Palliser Health Authority 1997
  
  Review of continuing care programs for Palliser Health Authority (Alberta). The study included: review of current programs and services; key stakeholder consultation and site visits; focus groups with continuing care users and their family caregivers; research regarding program innovations in continuing care; a population and bed forecast projection for the region; and development of program options.

• Hungary 1996-1997
  
  As part of a consortium retained by the Hungarian Ministry of Welfare, World Bank PMU on a Heart Healthy Nutrition Project, RMC's role was to provide assistance in project management, and health promotion.

• Republic of Georgia 1996-1997
  
  Provided financial management and procurement advisory services to the Georgia MOH, PCU on a World Bank funded project dealing with health systems, human resources, health financing and rehabilitation of health facilities.

• Belize 1996-1998
  
  RMC, in partnership with Cambridge Consulting Corporation, provided to the Belize MOH and Sports, advisory services to the Health Policy Reform Project. The objective is to increase the ability of the MOH to identify, design, implement and evaluate strategies and policies to improve efficiency, equity and quality of the Belizean health care system.

• Various Countries 1990's
  
  During the 1990's RMC organized and conducted Fellowship Programs for Ministers of Health and their senior officials from Estonia, Georgia, Lithuania, Poland, Slovenia and Ukraine, introducing them to the Canadian experience in health care restructuring.

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• Armenia 1996
  
  Retained by the Armenia Ministry of Health to provide advisory services dealing with primary health care as a forerunner to a World Bank funded project.

• Regional/District of Health Authoritities, Canada 1995-present
  
  RMC continues to work in health reform in Canada for Regional/District Health Authorities in Western Canada. Typical areas of involvement include determining health needs, trends and service requirements; identifying strategic options; recommending distribution of beds, service programs and location; evaluating the existing facilities, capacity for providing required services; and providing architectural block schematics for the purpose of planning and cost projections.

• Poland 1992-1993 & 1994-1996
  
  Assisted the Poland MOH in managing a US$135 million World Bank funded project. Provided advisory services to the MOH in policy formulation and strategic planning and the development of a work program for the introduction of a national health insurance. Emphasis was also placed on: health promotion, primary health care, health management training and education, pharmaceutical monitoring, MIS/IT, and physical evaluation of hospitals.

• Estonia 1995-1996
  
  Assisted the Estonian Minister of Social Affairs in managing a W.B. funded health sector project, including assistance in accounting, administration and procurement; development of course material for training of local architects in the design of health architects in the design of health facilities; and physical planning and cost estimation of a new Biomedical and Health Sciences Complex.

• Lithuania 1994-1996
  
  RMC provided advisory services to the Lithuanian Minister of Health and senior Ministry officials in policy formulation; health legislation; primary health care; health financing/cost recovery; organizational issues; management development/manpower planning; and other advisory services necessary for the development of an effective health care delivery.

• Turkey 1994
  
  Retained by Turkey MOH, Health Reform Project, to review proposed universal health insurance scheme, resulting in recommendations to modify the process and content of the Project.

• Slovenia 1994
  
  For the Slovenia Ministry of Health, RMC introduced Ministry officials to organization structures, management concepts and systems and procedures for health care delivery and assisted officials to identify those that would best serve Slovenian needs.

• Uganda 1992-1993
  
  Assisted the Uganda Ministry of Health to prepare for the Second World Bank Health Project. In addition to studies in institutional strengthening, decentralization, information systems and NGO/private-sector AIDS programming, also completed a detailed feasibility study of relocating the Ministry of Health Headquarters from Entebbe to Kampala.

• Belarus and Ukraine 1992
  
  RMC assessed the health care sector and type and nature of health care delivery in Belarus and Ukraine as part of the World Bank team.

• Bahamas 1988-1990
  
  In the Bahamas, RMC was involved in restructuring and institutional strengthening of the MOH. The work included policy formulation, planning and programming; formulation of health legislation; organization and managerial reforms; design and implementation of cost accounting and management information system; development and implementation of a supply management system and maintenance program.

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Prior to 1990

• BC Ministry of Health
  
  Reviewed emergency services in 10 hospitals for the B.C. Ministry of Health, addressing such issues as categories and functions; referrals and regional and district control; ambulance diversion and the availability of emergency and ICU beds in comparison to the anticipated level of requirement; and underlying problems and factors contributing to the present status.

• Saskatchewan
  
  For the Mental Health Services Branch of the Saskatchewan Government, RMC completed a strategic study of long-term psychiatric care including development of values, principles and delivery system functions for guiding future planning. A key issue was the future of one remaining long-term psychiatric care hospital in the province and the viability of deinstitutionalizing its residents by providing their care from a community base rather than from a single centralized provincial facility.

• Enviornmental Health, Alberta
  
  Studied strategic options for Environmental Health in Alberta to establish a framework for organizing environmental health programming among government departments and local health units. Reviewed health promotion methods, risk determination methods and epidemiological data to establish an agenda of health issues requiring priority attention by the government. The study developed definition of and responsibilities in environmental health for Alberta Health and its local health units.

• Govenrnment of Ontario
  
  Directed and jointly conducted a review of cancer services in Ontario with Coopers & Lybrand. The study examined respective mandates of Ontario Cancer Treatment and Research Foundation and Ontario Cancer Institute; examined and evaluated alternative options for their organizations; recommended changes i.e., programs, manpower, equipment and space; addressed cost implications; and proposed merging 2 organizations into a single provincial agency, resulting in a $200 million funding program by the government of Ontario.

• Bangladesh
  
  On behalf of Canadian International Development Agency, completed a multi-year family planning project in Bangladesh, included monitoring and improving procurement and distribution, research acceptance and effects of 18 million cycles of oral contraceptives.

• New Brunswick & Alberta
  
  Conducted an organization study of the 452-bed Dr. Everett Chalmers Hospital in Fredericton, New Brunswick; a similar study was also conducted for the 207-bed Glenrose Rehabilitation Hospital in Edmonton, Alberta.

• On behalf of Alberta Social Service and Community Health, RMC reviewed the Coordinated Home Care Program in Alberta and evaluated its performance after 4 years of operations.

• On behalf of Health and Welfare Canada, studied present and potential alcohol/drug problems in Northwest Territories and developed a strategic plan to provide effective, community-based prevention and treatment services.

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• On behalf of the government of Newfoundland, conducted a study of health care delivery in the Central Region; including a major review of 10 hospitals and development of strategic plan defining their new role. Undertook a similar study for Inuvik Region of NWT.

• Assessed health facility requirements in 2 health delivery sectors for Metro-Edmonton District 106 and examined options to meet perceived needs. Study team visited model health service and health maintenance organizations in Ontario and the United States.

• On behalf of the government of Alberta, con-ducted a feasibility study to establish the scope, anticipated costs and implications of developing a computer-based planning model capability to facilitate predesign planning of health care facilities, including needs analysis, definition of project scope and functional planning.

• Completed a comprehensive study of health care delivery in the Yukon Territory for Health and Welfare Canada. Study included needs assessment, operating system, planning requirements, and financial implications; also a master development plan for the Whitehorse General Hospital.

• RMC worked on a number of assignments over a 3-year period on behalf of the Alberta Children's Provincial Hospital (ACPH) and the Foothills Provincial General Hospital, including an examination of patient care, diagnostic services, human resources and medical/nursing education.

• For the Alberta Workers' Compensation Board Rehabilitation Centre, RMC completed operational review and a strategic management plan including development of mandate and objectives in area of rehabilitation, including service delivery model and implementation strategy.

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• Conducted study for Corrections Canada to determine the requirements for a Regional Health Centre to serve the needs of all Pacific Region (B.C.) correctional institutions and its potential viability with the Regional Psychiatric Centre.

• RMC offered advisory and executive search services to the University of Colorado to staff King Khalid Hospital, an 800-bed acute care facility, in Riyadh, Saudi Arabia.

• Developed strategic plan for delivery of geriatric and rehabilitation services for residents of Yukon Territory.

• On behalf of the N.W.T. Registered Nurses Association, RMC assessed future role of nursing within context of changes in the Canadian health care system and emerging issues in health care services for women in the Northwest Territories.

• Formulated a policy on palliative care for Alberta Hospitals and Medical Care, to serve as planning framework for the establishment of programs throughout Alberta.

Education

Universities and community colleges, which are called upon to develop programs and capital facilities that will respond to community and regional needs, are faced with competing and conflicting demands. RMC, with a multi-disciplinary staff and experience in planning post-secondary institutions, undertaking feasibility studies and organization and operations reviews, is well-suited to assist agencies responsible for providing education.

Typical Assignments are listed in Our Work in Facility Planning

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